Early follow-up after Xen implantation needed

March 5, 2018

NEW YORK — Nearly 80% of patients who received a Xen gel stent with IOP-lowering topical medication after surgery experienced an IOP of less than 18 mm Hg, but early interventions were needed in 20% of patients, according to a speaker here.

“Careful follow-up is necessary at 1 month as most failures, complications and need for medications clustered around this time,” Ramesh Ayyala, MD, FRCS, FRCOphth, said at the American Glaucoma Society annual meeting.

In a longitudinal retrospective study, 211 eyes underwent Xen (Allergan) implantation. At baseline, the mean IOP for the cohort was 22 mm Hg. Qualified success was defined as an IOP of 6 mm Hg to 18 mm Hg with IOP-lowering topical medications, while absolute success was defined as an IOP of 6 mm Hg to 18 mm Hg without additional topical medications, Ayyala said.

At 6 months postoperative, less than one-fourth of eyes (22%) were deemed to be absolute successes. Additionally, Ayyala said interventions were required in nearly 20% of all eyes, with most needling and injection interventions needed in the first postoperative month. – by Robert Linnehan

NEW YORK — Nearly 80% of patients who received a Xen gel stent with IOP-lowering topical medication after surgery experienced an IOP of less than 18 mm Hg, but early interventions were needed in 20% of patients, according to a speaker here.

“Careful follow-up is necessary at 1 month as most failures, complications and need for medications clustered around this time,” Ramesh Ayyala, MD, FRCS, FRCOphth, said at the American Glaucoma Society annual meeting.

In a longitudinal retrospective study, 211 eyes underwent Xen (Allergan) implantation. At baseline, the mean IOP for the cohort was 22 mm Hg. Qualified success was defined as an IOP of 6 mm Hg to 18 mm Hg with IOP-lowering topical medications, while absolute success was defined as an IOP of 6 mm Hg to 18 mm Hg without additional topical medications, Ayyala said.

At 6 months postoperative, less than one-fourth of eyes (22%) were deemed to be absolute successes. Additionally, Ayyala said interventions were required in nearly 20% of all eyes, with most needling and injection interventions needed in the first postoperative month. – by Robert Linnehan

The clinical implications of the study presented at the 2018 American Glaucoma Society annual meeting by Ayyala and colleagues are important.

The Xen gel stent (Allergan) is a safe and effective surgery for creating subconjunctival filtration in patients with refractory open-angle glaucoma. Personally, based on data from our center of seven glaucoma specialists, we have had good success with this surgery; however, it is not without risks and complications (eg, failures, erosion, needlings). This surgery still creates a bleb, and one needs to be comfortable with bleb management as well as needling. Studies from various authors report needling rates around 30% to 40%. We have found this rate to be consistent in our practice as well. Important, however, is that when needling with mitomycin C, we have found that the vast majority of patients do quite well, especially when one is able to avoid needling within the first month.

Our group plans to report on our 12-month data soon. I think it is important for various surgeons and various centers to report on their long-term data because glaucoma surgeons need to know what to expect when this device is used in the real world by a variety of surgeons in a wide variety of ethnic backgrounds and glaucomas.